Identifying adults with overweight or obesity who do not respond to early weight-loss efforts may help improve their chances for weight-loss success in the long term, according to research in Obesity.
In a study examining how adults with type 2 diabetes respond to a behavioral-based weight-loss intervention over time, researchers found that participants who lost the most body weight in the first 2 months saw the best long-term results after 8 years of follow-up.
“While behavioral weight-loss programs are effective for many individuals, there are also individuals who do not experience long-term weight-loss success,” Jessica L. Unick, PhD, assistant professor at the Warren Alpert Medical School at Brown University, Rhode Island, told Endocrine Today. “Previously, it has been difficult to predict who will and who will not experience success in a weight-loss program using demographic or baseline characteristics. However, our data are exciting because they suggest that we may be able to identify people very early (eg, within the first few weeks of a weight-loss program) who are at an increased likelihood of not achieving significant weight losses in both the short and long term.”
Jessica L. Unick
Unick and colleagues analyzed data from 2,290 adults aged 45 to 76 years with type 2 diabetes randomly assigned to the lifestyle intervention of the Look AHEAD trial (mean age, 59 years; mean BMI, 35.65 kg/m²; 59% women; 63% white). Study participants attended weekly treatment meetings and replaced two meals and one snack per day with a meal replacement product from months 1 to 6; participants attended three meetings per month and replaced one meal and one snack per day during months 7 to 12, and one meal or snack per day during years 2 to 8. Participants were assigned a physical activity regimen that gradually increased to more than 175 minutes per week by month 6. Researchers significantly reduced intervention between years 2 through 8.
Researchers grouped participants into one of three size categories based on 1-month weight change: less than 2% weight loss, between 2% and 4% weight loss, or greater than 4% weight loss. Researchers also grouped participants based on 2-month weight change: less than 3% weight loss, between 3% and 6% weight loss and greater than 6% weight loss.
Researchers found that greater weight loss at month 1 or 2 resulted in greater weight loss at any given year during the 8-year period. Participants who lost more than 6% body weight at month 2 had 3.85 times higher odds of achieving weight loss of greater than 5% at year 4 (95% CI, 3.05-4.88) and 2.28 times higher odds of greater than 5% weight loss at year 8 (95% CI, 1.81-2.89) when compared with participants who lost less than 3% body weight at month 2 (P < .0001). Participants who lost between 2% and 4% body weight at month 1 had 1.62 times higher odds of achieving greater than 5% weight loss at year 4 (95% CI, 1.32-1.98) and 1.28 times higher odds of greater than 5% weight loss at year 8 (95% CI, 1.05-1.58) compared with participants who lost less than 2% body weight.
“This is clinically significant because early identification could lead to early intervention for these individuals,” Unick said. “If we know that the recommended treatment program likely won’t be effective for many of these individuals with low weight losses within the first month of treatment, we can begin to explore other treatment options for them. This could include additional interventionist support, providing different dietary, exercise or behavioral strategies, the use of pharmacotherapy, or another alternative method. Future studies should begin to examine whether any of these early intervention strategies for ‘early non-responders’ are effective in ‘rescuing’ these individuals, thereby increasing their likelihood of achieving clinically significant weight losses long term” – by Regina Schaffer
Disclosure: Unick reports no relevant financial disclosures. One study author serves as chair of the scientific advisory board for Medifast Inc.